Doc­tors screen for do­mes­tic vi­o­lence

Penticton Herald - - LIVING - KEITH ROACH

DEAR DR. ROACH: Hav­ing re­cently changed doc­tors (due to a move), I filled out a new-pa­tient in­take. It had this ques­tion: “Do you feel safe in your home?”

It seemed like a ques­tion that might evoke a re­sponse for a lot of pos­si­ble is­sues that could make a per­son feel un­safe.

I’m pleased to know that my new doc­tor cares about the safety of her pa­tients, but what if a pa­tient is not ready to di­vulge an un­safe sit­u­a­tion, such as do­mes­tic vi­o­lence?

AN­SWER: Do­mes­tic vi­o­lence, also called in­ti­mate part­ner vi­o­lence, af­fects both women and men, but women are much, much more likely to be in­jured or killed by part­ner vi­o­lence than men are.

IPV can hap­pen in any so­cioe­co­nomic, eth­nic or age group, and it can be very hard to di­ag­nose. Physi­cians are in a good po­si­tion to in­ter­vene, but we of­ten do not ask and do not rec­og­nize the symp­toms or phys­i­cal signs of a per­son in an abu­sive re­la­tion­ship. I agree with rou­tinely ask­ing pa­tients about IPV, and in­clud­ing th­ese is­sues on a ques­tion­naire (ver­bally, elec­tronic or on pa­per) is a good way to screen for IPV.

I am in the habit now of telling all new pa­tients that I ask about part­ner vi­o­lence since I have seen so many cases. Of course, the pa­tient must be alone with his or her doc­tor when this is asked.

A per­son who is in an abu­sive re­la­tion­ship may not be ready to dis­close that fact to the doc­tor, and there are many po­ten­tial rea­sons for this.

There have been times when I have asked that ques­tion of a pa­tient and de­spite hear­ing a “no” an­swer, still sus­pected there might be an is­sue.

In that case, I tell the pa­tient that if she or he ever wants to talk more about it, I am avail­able to speak with, and will make a note to ask again on sub­se­quent vis­its.

I have had pa­tients come back to tell me that there was abuse even the first time I asked, but they weren’t ready to dis­cuss it (the first time you meet a new doc­tor, it’s hard to trust; also, many peo­ple who are abused blame them­selves, think the abuse will stop or do not know that the doc­tor has re­sources avail­able to help).

Some doc­tors worry that their pa­tients will be an­gry or em­bar­rassed at be­ing asked: That al­most never has been my ex­pe­ri­ence.

When I do see some­one who ad­mits to be­ing in an abu­sive re­la­tion­ship, I as­sure the pa­tient that I am there to help, and that his or her safety is my goal.

I con­vey that I know it can be hard to ad­mit the abuse. I rec­og­nize that her or his sit­u­a­tion is com­plex and that well-mean­ing ad­vice to im­me­di­ately leave may not be pos­si­ble or may make the sit­u­a­tion worse, so I avoid do­ing so ex­cept in very rare sit­u­a­tions.

I am for­tu­nate to have an ex­pe­ri­enced so­cial worker in my of­fice who has dealt with many such sit­u­a­tions and knows what ser­vices are avail­able.

There also are a va­ri­ety of com­mu­nity re­sources for women to dis­cuss their op­tions, and our of­fice keeps a list.

Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu

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